Provider Demographics
NPI:1962597641
Name:SCHWARTZ, MITCHELL L (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:L
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FAIRMOUNT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5457
Mailing Address - Country:US
Mailing Address - Phone:410-494-7921
Mailing Address - Fax:410-902-8247
Practice Address - Street 1:515 FAIRMOUNT AVE STE 500
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1662
Practice Address - Fax:410-494-1718
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044728207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
342191OtherMAMSI
MD055431600Medicaid
1442918OtherUNITED HEALTHCARE
MD0013OtherBLUE CHOICE/FEP
4800211OtherUNITED HEALTHCARE MCO
MD52823601 420AOtherBLUE SHIELD
MD055431600Medicaid
MD055431600Medicaid
MD0013OtherBLUE CHOICE/FEP